Drug treatment of hypertension in older persons in an academic hospital-based geriatrics practice

OBJECTIVE: To investigate the prevalence of hypertension in older persons, the prevalence of the different antihypertensive drugs used to treat hypert ension, the prevalence of the different antihypertensive drugs used to trea t hypertension in persons with prior myocardial infarction (MI) or congesti ve heart failure (CHF), and the prevalence of lowering the blood pressure t o <140/90 mm Hg with therapy. DESIGN: A retrospective analysis of charts from all older patients seen fro m December 1, 1997, through August 31, 1998, at an academic, hospital-based geriatrics practice was performed to investigate the prevalence of hyperte nsion in older persons, the prevalence of different antihypertensive drugs used to treat hypertension, the prevalence of different antihypertensive dr ugs used to treat hypertension in persons with prior MI or CHF, and the pre valence of lowering the blood pressure to <140/90 mm Hg with therapy. SETTING: An academic hospital-based geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. PATIENTS: A total of 459 men and 1369 women, mean age 80 +/- 8 years (range 59 to 101 years), were included in the study. MEASUREMENTS AND MAIN RESULTS: Hypertension was present in 1051 of the 1819 persons in the study (58%). Target organ damage, clinical cardiovascular d isease, or diabetes mellitus was present in 738 (70%) of these 1051 persons . Of the 1051 persons with hypertension, 520 (49%) were treated with diuret ics, 297 (28%) with beta-blockers, 445 (42%) with angiotensin-converting en zyme (ACE) inhibitors, 171 (16%) with calcium channel blockers, and 13 (1%) with other antihypertensive drugs; 41 (4%) received no antihypertensive th erapy. The last blood pressure recorded on the chart was <140/90 mm Hg for 735 of the 1051 persons (70%) with hypertension. Of 306 persons with hypert ension and prior MI, 182 (59%) were treated with beta-blockers, 146 (48%) w ith ACE inhibitors, 96 (31%) with diuretics, and 29 (9%) with calcium chann el blockers. Of 103 persons with hypertension and CHF, 103 (100%) were trea ted with diuretics, 94 (91%) with ACE inhibitors, 22 (21%) with beta-blocke rs, and 3 (3%) with calcium channel blockers. CONCLUSIONS: The prevalence of hypertension in the 1819 older persons seen in an academic, hospital-based geriatrics practice was 58%. Educational eff orts led to increased use of diuretics and beta-blockers and decreased use of calcium channel blockers in treating hypertension. The last blood pressu re recorded on the chart was <140/90 mm Hg in 70% of older persons with hyp ertension in the study.